Tsai-Wei Huang1, Ken N Kuo2, Kee-Hsin Chen3, Chiehfeng Chen4, Wen-Hsuan Hou5, Wei-Hwa Lee6, Tsu-Yi Chao7, Jo-Ting Tsai8, Chih-Ming Su9, Ming-Te Huang10, Ka-Wai Tam11. 1. Department of Nursing, College of Medicine and Nursing, HungKuang University, Taichung City, Taiwan. 2. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. 3. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan. 4. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. 5. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; School of Gerontology Healthcare Management, College of Nursing, Taipei Medical University, Taipei, Taiwan. 6. Department of Pathology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan. 7. Division of Hematology/Oncology, Department of Medicine, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan. 8. Department of Radiation Oncology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Department of Radiation Oncology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 9. Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan. 10. Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 11. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: kelvintam@h.tmu.edu.tw.
Abstract
BACKGROUND: In 2014, the American Society of Clinical Oncology published an updated clinical practice guideline on axillary lymph node dissection (ALND) for early-stage breast cancer patients. However, these recommendations have been challenged because they were based on data from only one randomized controlled trial (RCT). We evaluated the rationale of these recommendations by systematically reviewing RCTs using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. METHODS: We searched articles in the PubMed, EMBASE, CINAHL, Scopus, and Cochrane databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and surgical complications of axillary dissection. The quality of evidence was assessed using the GRADE profiler. RESULTS: Five eligible studies were retrieved and analyzed. We divided sentinel lymph node (SLN) metastasis into two categories: SLN micrometastasis and SLN macrometastasis. In patients with 1 or 2 SLN micrometastasis, no significant difference was observed in OS, DFS, or recurrence rate between the ALND and non-ALND groups. For patients with 1 or 2 SLN marcometastasis, only one trial with a moderate risk of bias was included, and non-ALND was the preferred management overall. However, ALND might be appropriate for patients who placed a greater emphasis on longer-term survival at any cost. CONCLUSION: We recommend non-ALND management for early breast cancer patients with 1 or 2 SLN micrometastasis or macrometastasis on the basis of a systematic review of the current evidence conducted using the GRADE system. However, the optimal practice of evidence-based medicine should incorporate patient preferences, particularly when evidence is limited.
BACKGROUND: In 2014, the American Society of Clinical Oncology published an updated clinical practice guideline on axillary lymph node dissection (ALND) for early-stage breast cancerpatients. However, these recommendations have been challenged because they were based on data from only one randomized controlled trial (RCT). We evaluated the rationale of these recommendations by systematically reviewing RCTs using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. METHODS: We searched articles in the PubMed, EMBASE, CINAHL, Scopus, and Cochrane databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and surgical complications of axillary dissection. The quality of evidence was assessed using the GRADE profiler. RESULTS: Five eligible studies were retrieved and analyzed. We divided sentinel lymph node (SLN) metastasis into two categories: SLN micrometastasis and SLN macrometastasis. In patients with 1 or 2 SLN micrometastasis, no significant difference was observed in OS, DFS, or recurrence rate between the ALND and non-ALND groups. For patients with 1 or 2 SLN marcometastasis, only one trial with a moderate risk of bias was included, and non-ALND was the preferred management overall. However, ALND might be appropriate for patients who placed a greater emphasis on longer-term survival at any cost. CONCLUSION: We recommend non-ALND management for early breast cancerpatients with 1 or 2 SLN micrometastasis or macrometastasis on the basis of a systematic review of the current evidence conducted using the GRADE system. However, the optimal practice of evidence-based medicine should incorporate patient preferences, particularly when evidence is limited.
Authors: Alessandro Fancellu; Xue Yun Zhao; Pietrina Cottu; Valeria Sanna; Yuan Ping Li; Qin Zhu; Cinzia Tanda; Ying Yi Zhang; Yan Mei Lai; Giorgio Carlo Ginesu; Shu Qin Dai; Alberto Porcu Journal: Breast Care (Basel) Date: 2020-01-21 Impact factor: 2.860
Authors: Amelie de Gregorio; Peter Widschwendter; Susanne Albrecht; Nikolaus de Gregorio; Thomas W P Friedl; Jens Huober; Wolfgang Janni; Florian K Ebner Journal: Geburtshilfe Frauenheilkd Date: 2018-11-26 Impact factor: 2.915